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RECURRENCE IN MALAYSIA
NORLIZA MAT ARIFFIN, FARIDA ISLAHUDIN* , ENDANG KUMOLOSASI AND MOHD MAKMOR-BAKRY
AS THE BACKGROUND
The incidence of malaria caused by Plasmodium vivax is about 16 million cases worldwide
Malaria causes 3100 deaths worldwide, with 86% occurring outside Africa, especially in Southeast Asia and the
Eastern Mediterranean region
The aim of this study was to develop a tool to identify patients infected with P. vivax who are at high risk of
recurrence in Malaysia
METODE
Research design
A retrospective study was conducted from 2011 to 2016. The data were obtained through the
National Malaria Case Registry (NMCR) under the Borne Vector Disease Sector, Disease Control
Division, Ministry of Health, Malaysia.
patients diagnosed with P. vivax infection and treated with primaquine were included in the study.
Patients with missing data and those not monitored for at least 6 months after exclusion were
excluded from the study. To develop a predictive risk recurrence model, the study sample was
divided into 2 groups.
Definitions used in the study
all cases categorized in relapse, are called recurrence because of the inability to distinguish between relapse,
reinfection or recrudescence. Clinical outcomes were measured by relapse during
follow ups of 6- to 12 months, as determined from a positive blood smear parasite (BFMP) test. Patient
are actively monitored due to parasites on monthly basis by the health office as recommended
by current clinical practice in P. vivax management
HASIL
The area under the ROC curve demonstrated the model was reliable with a
value of 0.766 (95% CI: 0.700–0.833; p < 0.001; Fig. 2B)
indicating that the accuracy of the model was good [23]. The trade-
off value of the score was 3.5, which represents 91.5% sensitivity and
57.7% specificity in predicting the presence or absence of recurrence
DISKUSI
The growing evidence suggests that malaria caused by P. vivax is no longer considered a benign
and non-fatal disease. Although various precautions, complete elimination of P. vivax has become
very challenging because of its ability to recur within weeks and months after primary
parasitemia
tight monitoring of patients with P. vivax infection and identifying those at higher risk of recurrence is
essential for better control and eradication of the disease
Recent studies have shown that predictors of recurrence of P. vivax infection At local settings
younger age, higher gametocyte upon admission, native transmission, combination of
treatment with chloroquine and primaquine as well as incomplete primaquine treatment
supervision of primaquine administration every day to ensure that primaquine
treatment is completed is a better approach in high-risk populations. This can
ensure the success of primaquine in the management of P. vivax infections.
this is the first time a clinical recurrence predictor has been developed using
national data. Evidently, this tool is found as a good redictor, and can be used when
released by health care workers to identify high recurrence risk among treated
patients
In this study proposes to apply a strict malaria program in patients, with a>> 3.5
score, which has a higher risk of recurrence
KETERBATASAN
Possible researchers have not identified all patients with recurrence, because of the
loss of follow-up of a large number of cases
In the registry, details not identified in variables such as G6PD, case locality, case
locality status, previous malaria infection, presence of gametocytes during
admission, severity, and status of primary treatment were categorized unknown
Generalization of current research should also be done with caution. Due to differences in population
demographics, and management of clinical and antimalarial medications in Malaysia, compared to other regions,
the results of the scores may differ
KESIMPULAN